Developing an Implementation Plan: Breastfeeding Problem in Young Mothers


Before implementing the writer’s plan of action of ensuring that new mothers breastfeed their infants till the recommended period, approval would be obtained in writing from the supervisors. The message about the program would then be circulated among fellow staff and other health personnel coming into contact with the expectant mothers as they would be the main participants in the educational program.

The letter will contain all information as to the reason for this program, the present behavior among the expectant mothers and the actual number of breastfeeding mothers as noted in the wards. The steps to be taken for implementation will be chalked out. Convenient dates and time would be suggested and the educational program will be held on ten days with an expected attendance of one hundred and fifty participants each notified earlier.

Present problem

The Association of Women’s Health, Obstetric and Neonatal Nurses has recommended that skin-to-skin contact needs to be initiated just after birth and breastfeeding to be begun within the first hour (2007). Another author considers breastfeeding important as it provides “nutritional, immunological, cognitive and psychological benefits” (Fitzpatrick et al, 2006). However this importance is not evident in our settings.

Currently working in a transitional care unit in a sub-acute care hospital, this writer comes into contact with preemies and infants. Proper nursing care of the new mothers and their babies is her job. However she is not totally satisfied with the breastfeeding support that the new mothers need to have. The mothers also are unaware about the duration and the benefits of breastfeeding. Lack of proper support has probably even produced a negative impact on them.

The mothers have a tendency to stop breastfeeding long before the recommended period; being ignorant that breastfeeding promotes child health (Tohotoa et al, 2009). Community attitudes may have influenced the mothers (Hector et al, 2005). They may also be shy of feeding in public.

The use of artificial formulas soon after birth is another hazard noted. Supplementing breast milk with artificial formula is a common but unacceptable practice as far as the baby is concerned and the practice is not evidence-based. The duration of breastfeeding becomes inevitably shorter.

The lack of lactation consultants, who must be ready to provide support all round the clock, is one main drawback. Some mothers are misinformed that their breastfeeding could cause the breasts to sag. This cosmetic misconception is an issue for many of them. The result is that they do not breastfeed, denying their child welfare and health. In addition they have difficulty in accepting any support.

A disturbing factor is that new mothers are not followed up after discharge and there are no statistics as to how long they continue with breastfeeding. Outcomes could be sub-optimal.

The development of sore nipples may be associated with the frequency of the feeding and ignorance may cause the mother to stop feeding. This is one physical situation among many where adequate support is essential.

The overall well-being of the mother and her baby is compromised without the breastfeeding support. Lack of information prevents the mother from handling possible problems like clogged breasts, nipple discomfort and inadequate feeding positions. Premature termination of the breastfeeding causes detrimental growth and development of the child. Breastfeeding barriers can therefore be summarized under physical, inadequate knowledge and lack of support (Tohotoa, 2009).

Possible solution

Using the Health belief model, this writer has planned to have an education program for all the staff and others who come into close contact with the new mothers. The provision of support from all quarters should be the target of this exercise. Policy changes should start from the antenatal outpatient clinics, extend to the maternity wards and continue during the postnatal period through focus groups. Lactation consultants could start their support from the antenatal period. Starting early will produce a convincing change in the behaviors and beliefs of the potential mothers and their partners as the Health Belief Model implies. Health professionals must also participate in the provision of support, however small.

Rationale for selecting proposed solution

Several theories have been attributed to the health behaviors for the breastfeeding: “the theory of planned behavior, health belief model, social cognitive theory and the social ecological theory” (Fitzpatrick and Wallace, 2006). This writer aims to use the Health Belief Model which helps us to understand “the mediators of health-related behaviors” (Shumaker et al, 2009). Health-promoting behaviors are believed to be influenced directly and indirectly by “10 determinants of individual characteristics and experiences” (Pender et al, 2002).

The inference is that individuals are influenced by determinants which are perceived benefits or barriers of the health-promoting actions or interpersonal or situational influences. A critical review of selected research articles will decide the possible results, the changes that could be made, what the influencing factors were and the changes necessary to improve the breastfeeding habit. This writer would then develop a plan of action that is in line with the health-promoting factors that have been identified by the health promotion model by other researchers.

Review of literature

Nurses’ support was studied by conducting audio-taped interviews using the phenomenological method (Hong et al, 2003). The 20 primiparous mothers interviewed were mostly happy with the “emotional, informational and tangible support. Non-supportive behaviors were also recognized. Among nurses, the intra-partum nursing care provides the maximum support for breastfeeding (Morin, 2009).

A cross-sectional study compared rates of breastfeeding at two hospitals, one of which employed qualified lactation consultants (Castrucci et al, 2006). The presence of the lactation consultant produced better breastfeeding results (2.28 times) than the other, adjusting for “race/ethnicity, education, insurance status, age, marital status, route of delivery, birth weight, and gestational age” (Castrucci et al, 2006).

A study was conducted to find out the changes in breastfeeding in a province at Somdet Hospital in Kalasin Province after the application of the health belief model (Reankittiwat, 2008). A good response was seen. Perceived barriers fell to a low level. Risk of inappropriate feeding was high so breastfeeding was intensified. Social support was at a high level. The changes in behavior following the support spoke for the health belief model.

Three groups of ladies received different methods of education on breastfeeding during the pre-natal period in a study (Rosen et al, 2008). All the different methods produced an equal improvement in the breastfeeding at six months.

Cricco-Liza (2009) conducted a study at an NICU using an ethnographic approach to study the changes if any in the structure and process of the breastfeeding promotion over a 14-month period by a network of support. There were consistent messages by the nursing staff and inconsistent messages by other health personnel which led to an increase in the current breastfeeding and increased acceptance of a prolonged breastfeeding process (Cricco-Liza, 2009).

Tohotoa et al (2009) discovered that spouses who shared the experience of childbirth went on to support each other on infant feeding practices suggesting the role of the father in breastfeeding. The fathers had given strong emotional and physical support.

The review supports this writer’s decision to promote the breastfeeding through education of the nurses mainly for consistent messages and also include the other health personnel for at least inconsistent messages (Cricco-Liza, 2009). The same thought is echoed by Hong et al (2003) who found that the nurses provide emotional, informational and tangible support. The advantage of the inclusion of the husbands in the education program by using online questionnaires and messages helps promotion further (Tohotoa, 2009). The use of lactation consultants helps the promotion (Castrucci, 2006). Whatever the method of education used, the breastfeeding is definitely increased (Rosen et al, 2008). This writer is further motivated by the fact that the promotion can start in the pre-natal period (Rosen et al, 2008).

Implementation logistics

The change will be set in force into the current work organization after the education of the Staff and husbands. The writer will be responsible for the initiation of the change. She will also be responsible for the education of the staff and overseeing of the implementation process.

Resources required for implementation:

  • Staff.
  • Educational Materials: pamphlets, handouts, posters, and PowerPoint presentations.
  • Assessment Tools: questionnaires, surveys, pre-/posttests to assess knowledge of participants at baseline and after intervention.
  • Technology: technology or software needs. Online questionnaires and messages for the male counterparts.
  • Funds: cost of educating staff, printing or producing educational materials, gathering and analyzing data (before, during, and following implementation), and staff to initiate, oversee, and evaluate change.


Castrucci, B.C. (2006). A Comparison of Breastfeeding Rates in an Urban Birth Cohort Among Women Delivering Infants at Hospitals That Employ and Do Not Employ Lactation Consultants. Journal of Public Health Management & Practice, November/December 2006 Volume 12 Number 6 Pages 578 – 585. Web.

Cricco-Liza, R. (2009). Rooting for the Breast: Breastfeeding Promotion in the NICU. MCN, The American Journal of Maternal/Child Nursing, Volume 34 Number 6 Pages 356 – 364. Web.

Fitzpatrick, J.J. and Wallace, M. (2006). Encyclopaedia of Nursing Research, Springer Publishing Company, New York. Web.

Hector, D., King, L., Webb, K., Heywood, P. (2005). Factors affecting breastfeeding practices. Applying a conceptual framework. NSW Public Health Bull, Vol. 16, p 52-55. Web.

Hong, T.M., Callister, L.C. and Schwartz, R. (2003) First Time Mothers’ Views of Breastfeeding Support From Nurses MCN, The American Journal of Maternal/Child Nursing Volume 28 Number 1 Pages 10 – 15. Web.

Morin, K.H. (2009). Breastfeeding immediately after birth. MCN (The American Journal of Maternal/Child Nursing), January/February 2009. Published by Wolters Kluwer/Lippincott Williams and Wilkins. Web.

Pender, N., Murdaugh, C., & Parsons, M.A. (2002). Health promotion in nursing practice. Upper Saddle River, NJ: Prentice Hall.

Reankittiwat, M.D., (2008) The study of Health Belief Model, Social support among the post-partum women for time to breastfeeding in Somdet District Kalasin Province. Khon Kaen Hospital Medical Journal, Vol. 32, Supplement. Web.

Rosen, I.M., Krueger, M.V., Carney, L.M., and Graham, J.A. (2008). Pre-natal breastfeeding education and breastfeeding outcomes. MCN, The American Journal of Maternal/Child Nursing, Volume 33 Number 5 Pages 315 – 319. Web.

Shumaker, S.A., Ockene J.K., Riekert, K.A. (2009). Handbook of health behavior change. Springer Publishing Company. P. 48. Web.

Tohotoa, J., Maycock, B., Hauck, Y.L., Howat, P., Burns, S. and Binns, C.W. (2009). Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. International Breastfeeding Journal, Vol. 4, No. 15. Published by Biomed Central. Web.